Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY

Professional

Both

$623.00

Service Code	HCPCS 33233
Min. Negotiated Rate	$147.40
Max. Negotiated Rate	$702.64
Rate for Payer: Aetna Commercial	$309.82
Rate for Payer: BCBS Complete	$154.77
Rate for Payer: BCBS Trust/PPO	$702.64
Rate for Payer: Cash Price	$498.40
Rate for Payer: Cash Price	$498.40
Rate for Payer: Meridian Medicaid	$154.77
Rate for Payer: Priority Health Choice Medicaid	$147.40
Rate for Payer: Priority Health Cigna Priority Health	$436.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$369.18
Rate for Payer: Priority Health Narrow Network	$369.18
Rate for Payer: Priority Health SBD	$369.18
Rate for Payer: UMR Bronson Commercial	$286.58

PR REMOVAL PERQ LEFT HRT VAD ARTL/ARTL&VEN SEP INSJ

Professional

Both

$552.00

Service Code	HCPCS 33992
Min. Negotiated Rate	$117.15
Max. Negotiated Rate	$1,321.81
Rate for Payer: Aetna Commercial	$252.98
Rate for Payer: BCBS Complete	$123.01
Rate for Payer: BCBS Trust/PPO	$1,321.81
Rate for Payer: Cash Price	$441.60
Rate for Payer: Cash Price	$441.60
Rate for Payer: Meridian Medicaid	$123.01
Rate for Payer: Priority Health Choice Medicaid	$117.15
Rate for Payer: Priority Health Cigna Priority Health	$386.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$290.98
Rate for Payer: Priority Health Narrow Network	$290.98
Rate for Payer: Priority Health SBD	$290.98
Rate for Payer: UMR Bronson Commercial	$253.92

PR REMOVAL POSTERIOR NONSEGMENTAL INSTRUMENTATION

Professional

Both

$2,061.00

Service Code	HCPCS 22850
Min. Negotiated Rate	$89.99
Max. Negotiated Rate	$1,442.70
Rate for Payer: Aetna Commercial	$979.88
Rate for Payer: BCBS Complete	$500.52
Rate for Payer: BCBS Trust/PPO	$89.99
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Cash Price	$1,648.80
Rate for Payer: Meridian Medicaid	$500.52
Rate for Payer: Priority Health Choice Medicaid	$476.69
Rate for Payer: Priority Health Cigna Priority Health	$1,442.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,131.60
Rate for Payer: Priority Health Narrow Network	$1,131.60
Rate for Payer: Priority Health SBD	$1,131.60
Rate for Payer: UMR Bronson Commercial	$948.06

PR REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION

Professional

Both

$2,188.00

Service Code	HCPCS 22852
Min. Negotiated Rate	$459.65
Max. Negotiated Rate	$1,531.60
Rate for Payer: Aetna Commercial	$941.89
Rate for Payer: BCBS Complete	$482.63
Rate for Payer: BCBS Trust/PPO	$648.97
Rate for Payer: Cash Price	$1,750.40
Rate for Payer: Cash Price	$1,750.40
Rate for Payer: Meridian Medicaid	$482.63
Rate for Payer: Priority Health Choice Medicaid	$459.65
Rate for Payer: Priority Health Cigna Priority Health	$1,531.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,089.21
Rate for Payer: Priority Health Narrow Network	$1,089.21
Rate for Payer: Priority Health SBD	$1,089.21
Rate for Payer: UMR Bronson Commercial	$1,006.48

PR REMOVAL PROSTHETIC MATRL ABDL WALL FOR INFECTION

Professional

Both

$809.00

Service Code	HCPCS 11008
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$566.30
Rate for Payer: Aetna Commercial	$300.89
Rate for Payer: BCBS Complete	$180.70
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: Cash Price	$647.20
Rate for Payer: Cash Price	$647.20
Rate for Payer: Meridian Medicaid	$180.70
Rate for Payer: Priority Health Choice Medicaid	$172.10
Rate for Payer: Priority Health Cigna Priority Health	$566.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$332.12
Rate for Payer: Priority Health Narrow Network	$332.12
Rate for Payer: Priority Health SBD	$332.12
Rate for Payer: UMR Bronson Commercial	$372.14

PR REMOVAL SHOULDER FOREIGN BODY DEEP SUBFASCIAL/IM

Professional

Both

$929.00

Service Code	HCPCS 23333
Min. Negotiated Rate	$75.14
Max. Negotiated Rate	$730.75
Rate for Payer: Aetna Commercial	$630.21
Rate for Payer: BCBS Complete	$324.07
Rate for Payer: BCBS Trust/PPO	$75.14
Rate for Payer: Cash Price	$743.20
Rate for Payer: Cash Price	$743.20
Rate for Payer: Meridian Medicaid	$324.07
Rate for Payer: Priority Health Choice Medicaid	$308.64
Rate for Payer: Priority Health Cigna Priority Health	$650.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$730.75
Rate for Payer: Priority Health Narrow Network	$730.75
Rate for Payer: Priority Health SBD	$730.75
Rate for Payer: UMR Bronson Commercial	$427.34

PR REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15

Professional

Both

$172.00

Service Code	HCPCS 11200
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$1,422.75
Rate for Payer: Aetna Commercial	$79.26
Rate for Payer: BCBS Complete	$51.66
Rate for Payer: BCBS Trust/PPO	$1,422.75
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cash Price	$137.60
Rate for Payer: Meridian Medicaid	$51.66
Rate for Payer: Priority Health Choice Medicaid	$49.20
Rate for Payer: Priority Health Cigna Priority Health	$120.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$93.71
Rate for Payer: Priority Health Narrow Network	$93.71
Rate for Payer: Priority Health SBD	$93.71
Rate for Payer: UMR Bronson Commercial	$79.12

PR REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10

Professional

Both

$44.00

Service Code	HCPCS 11201
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$106.97
Rate for Payer: Aetna Commercial	$17.88
Rate for Payer: BCBS Complete	$10.73
Rate for Payer: BCBS Trust/PPO	$106.97
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Meridian Medicaid	$10.73
Rate for Payer: Priority Health Choice Medicaid	$10.22
Rate for Payer: Priority Health Cigna Priority Health	$30.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20.14
Rate for Payer: Priority Health Narrow Network	$20.14
Rate for Payer: Priority Health SBD	$20.14
Rate for Payer: UMR Bronson Commercial	$20.24

PR REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR

Professional

Both

$263.00

Service Code	HCPCS 33286
Min. Negotiated Rate	$53.68
Max. Negotiated Rate	$2,454.48
Rate for Payer: Aetna Commercial	$116.81
Rate for Payer: BCBS Complete	$56.36
Rate for Payer: BCBS Trust/PPO	$2,454.48
Rate for Payer: Cash Price	$210.40
Rate for Payer: Cash Price	$210.40
Rate for Payer: Meridian Medicaid	$56.36
Rate for Payer: Priority Health Choice Medicaid	$53.68
Rate for Payer: Priority Health Cigna Priority Health	$184.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$135.65
Rate for Payer: Priority Health Narrow Network	$135.65
Rate for Payer: Priority Health SBD	$135.65
Rate for Payer: UMR Bronson Commercial	$120.98

PR REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA

Professional

Both

$44.00

Service Code	HCPCS 15854
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$452.03
Rate for Payer: Aetna Commercial	$16.42
Rate for Payer: BCBS Complete	$17.60
Rate for Payer: BCBS Trust/PPO	$452.03
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Priority Health Cigna Priority Health	$30.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19.73
Rate for Payer: Priority Health Narrow Network	$19.73
Rate for Payer: Priority Health SBD	$19.73
Rate for Payer: UMR Bronson Commercial	$20.24

PR REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA

Professional

Both

$31.00

Service Code	HCPCS 15853
Min. Negotiated Rate	$11.61
Max. Negotiated Rate	$10,615.31
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: BCBS Trust/PPO	$10,615.31
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$21.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.97
Rate for Payer: Priority Health Narrow Network	$13.97
Rate for Payer: Priority Health SBD	$13.97
Rate for Payer: UMR Bronson Commercial	$14.26

PR REMOVAL SUTURES/STAPLES REQUIRING ANESTHESIA

Professional

Both

$157.00

Service Code	HCPCS 15851
Min. Negotiated Rate	$41.54
Max. Negotiated Rate	$272.27
Rate for Payer: Aetna Commercial	$49.70
Rate for Payer: BCBS Complete	$43.62
Rate for Payer: BCBS Trust/PPO	$272.27
Rate for Payer: Cash Price	$125.60
Rate for Payer: Cash Price	$125.60
Rate for Payer: Meridian Medicaid	$43.62
Rate for Payer: Priority Health Choice Medicaid	$41.54
Rate for Payer: Priority Health Cigna Priority Health	$109.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$79.33
Rate for Payer: Priority Health Narrow Network	$79.33
Rate for Payer: Priority Health SBD	$79.33
Rate for Payer: UMR Bronson Commercial	$72.22

PR REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON

Professional

Both

$222.00

Service Code	HCPCS 15850
Min. Negotiated Rate	$88.80
Max. Negotiated Rate	$155.40
Rate for Payer: BCBS Complete	$88.80
Rate for Payer: Cash Price	$177.60
Rate for Payer: Priority Health Cigna Priority Health	$155.40
Rate for Payer: UMR Bronson Commercial	$102.12

PR REMOVAL TISSUE EXPANDER W/O INSERTION IMPLANT

Professional

Both

$912.00

Service Code	HCPCS 11971
Min. Negotiated Rate	$355.50
Max. Negotiated Rate	$679.45
Rate for Payer: Aetna Commercial	$589.15
Rate for Payer: BCBS Complete	$373.28
Rate for Payer: BCBS Trust/PPO	$394.67
Rate for Payer: Cash Price	$729.60
Rate for Payer: Cash Price	$729.60
Rate for Payer: Meridian Medicaid	$373.28
Rate for Payer: Priority Health Choice Medicaid	$355.50
Rate for Payer: Priority Health Cigna Priority Health	$638.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$679.45
Rate for Payer: Priority Health Narrow Network	$679.45
Rate for Payer: Priority Health SBD	$679.45
Rate for Payer: UMR Bronson Commercial	$419.52

PR REMOVAL TUNNELED INTRAPERITONEAL CATHETER

Professional

Both

$962.00

Service Code	HCPCS 49422
Min. Negotiated Rate	$140.15
Max. Negotiated Rate	$906.56
Rate for Payer: Aetna Commercial	$299.91
Rate for Payer: BCBS Complete	$147.16
Rate for Payer: BCBS Trust/PPO	$906.56
Rate for Payer: Cash Price	$769.60
Rate for Payer: Cash Price	$769.60
Rate for Payer: Meridian Medicaid	$147.16
Rate for Payer: Priority Health Choice Medicaid	$140.15
Rate for Payer: Priority Health Cigna Priority Health	$673.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$385.12
Rate for Payer: Priority Health Narrow Network	$385.12
Rate for Payer: Priority Health SBD	$385.12
Rate for Payer: UMR Bronson Commercial	$442.52

PR REMOVAL VENTR ASSIST DEVICE XTRCORP 1 VENTRICLE

Professional

Both

$3,314.00

Service Code	HCPCS 33977
Min. Negotiated Rate	$107.24
Max. Negotiated Rate	$2,319.80
Rate for Payer: Aetna Commercial	$1,503.29
Rate for Payer: BCBS Complete	$736.26
Rate for Payer: BCBS Trust/PPO	$107.24
Rate for Payer: Cash Price	$2,651.20
Rate for Payer: Cash Price	$2,651.20
Rate for Payer: Meridian Medicaid	$736.26
Rate for Payer: Priority Health Choice Medicaid	$701.20
Rate for Payer: Priority Health Cigna Priority Health	$2,319.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,744.82
Rate for Payer: Priority Health Narrow Network	$1,744.82
Rate for Payer: Priority Health SBD	$1,744.82
Rate for Payer: UMR Bronson Commercial	$1,524.44

PR REMOVAL WRIST PROSTH COMPLICATED W/TOTAL WRIST

Professional

Both

$1,325.00

Service Code	HCPCS 25251
Min. Negotiated Rate	$466.90
Max. Negotiated Rate	$2,000.67
Rate for Payer: Aetna Commercial	$960.15
Rate for Payer: BCBS Complete	$490.24
Rate for Payer: BCBS Trust/PPO	$2,000.67
Rate for Payer: Cash Price	$1,060.00
Rate for Payer: Cash Price	$1,060.00
Rate for Payer: Meridian Medicaid	$490.24
Rate for Payer: Priority Health Choice Medicaid	$466.90
Rate for Payer: Priority Health Cigna Priority Health	$927.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,109.13
Rate for Payer: Priority Health Narrow Network	$1,109.13
Rate for Payer: Priority Health SBD	$1,109.13
Rate for Payer: UMR Bronson Commercial	$609.50

PR REMOVE BILE DUCT STONE, PERCUT

Professional

Both

$886.00

Service Code	HCPCS 47630
Min. Negotiated Rate	$354.40
Max. Negotiated Rate	$620.20
Rate for Payer: BCBS Complete	$354.40
Rate for Payer: Cash Price	$708.80
Rate for Payer: Priority Health Cigna Priority Health	$620.20
Rate for Payer: UMR Bronson Commercial	$407.56

PR REMOVE DEEP SHOULDER FOREIGN BODY

Professional

Both

$1,019.00

Service Code	HCPCS 23331
Min. Negotiated Rate	$407.60
Max. Negotiated Rate	$713.30
Rate for Payer: BCBS Complete	$407.60
Rate for Payer: Cash Price	$815.20
Rate for Payer: Priority Health Cigna Priority Health	$713.30
Rate for Payer: UMR Bronson Commercial	$468.74

PR REMOVE NAIL BED/FINGER TIP

Professional

Both

$520.00

Service Code	HCPCS 11752
Min. Negotiated Rate	$208.00
Max. Negotiated Rate	$364.00
Rate for Payer: BCBS Complete	$208.00
Rate for Payer: Cash Price	$416.00
Rate for Payer: Priority Health Cigna Priority Health	$364.00
Rate for Payer: UMR Bronson Commercial	$239.20

PR REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL

Professional

Both

$2,052.00

Service Code	HCPCS 50385
Min. Negotiated Rate	$134.40
Max. Negotiated Rate	$2,060.90
Rate for Payer: Aetna Commercial	$279.88
Rate for Payer: BCBS Complete	$141.12
Rate for Payer: BCBS Trust/PPO	$2,060.90
Rate for Payer: Cash Price	$1,641.60
Rate for Payer: Cash Price	$1,641.60
Rate for Payer: Meridian Medicaid	$141.12
Rate for Payer: Priority Health Choice Medicaid	$134.40
Rate for Payer: Priority Health Cigna Priority Health	$1,436.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$342.05
Rate for Payer: Priority Health Narrow Network	$342.05
Rate for Payer: Priority Health SBD	$342.05
Rate for Payer: UMR Bronson Commercial	$943.92

PR REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER

Professional

Both

$1,886.00

Service Code	HCPCS 53446
Min. Negotiated Rate	$410.24
Max. Negotiated Rate	$1,320.20
Rate for Payer: Aetna Commercial	$823.67
Rate for Payer: BCBS Complete	$430.75
Rate for Payer: BCBS Trust/PPO	$437.96
Rate for Payer: Cash Price	$1,508.80
Rate for Payer: Cash Price	$1,508.80
Rate for Payer: Meridian Medicaid	$430.75
Rate for Payer: Priority Health Choice Medicaid	$410.24
Rate for Payer: Priority Health Cigna Priority Health	$1,320.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,026.14
Rate for Payer: Priority Health Narrow Network	$1,026.14
Rate for Payer: Priority Health SBD	$1,026.14
Rate for Payer: UMR Bronson Commercial	$867.56

PR REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD

Professional

Both

$688.00

Service Code	HCPCS 33227
Min. Negotiated Rate	$213.64
Max. Negotiated Rate	$1,104.68
Rate for Payer: Aetna Commercial	$454.03
Rate for Payer: BCBS Complete	$224.32
Rate for Payer: BCBS Trust/PPO	$1,104.68
Rate for Payer: Cash Price	$550.40
Rate for Payer: Cash Price	$550.40
Rate for Payer: Meridian Medicaid	$224.32
Rate for Payer: Priority Health Choice Medicaid	$213.64
Rate for Payer: Priority Health Cigna Priority Health	$481.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$534.09
Rate for Payer: Priority Health Narrow Network	$534.09
Rate for Payer: Priority Health SBD	$534.09
Rate for Payer: UMR Bronson Commercial	$316.48

PR REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS

Professional

Both

$713.00

Service Code	HCPCS 33228
Min. Negotiated Rate	$223.01
Max. Negotiated Rate	$864.30
Rate for Payer: Aetna Commercial	$475.59
Rate for Payer: BCBS Complete	$234.16
Rate for Payer: BCBS Trust/PPO	$864.30
Rate for Payer: Cash Price	$570.40
Rate for Payer: Cash Price	$570.40
Rate for Payer: Meridian Medicaid	$234.16
Rate for Payer: Priority Health Choice Medicaid	$223.01
Rate for Payer: Priority Health Cigna Priority Health	$499.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$557.49
Rate for Payer: Priority Health Narrow Network	$557.49
Rate for Payer: Priority Health SBD	$557.49
Rate for Payer: UMR Bronson Commercial	$327.98

PR REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD

Professional

Both

$567.00

Service Code	HCPCS 33229
Min. Negotiated Rate	$234.51
Max. Negotiated Rate	$1,010.11
Rate for Payer: Aetna Commercial	$502.63
Rate for Payer: BCBS Complete	$246.24
Rate for Payer: BCBS Trust/PPO	$1,010.11
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cash Price	$453.60
Rate for Payer: Meridian Medicaid	$246.24
Rate for Payer: Priority Health Choice Medicaid	$234.51
Rate for Payer: Priority Health Cigna Priority Health	$396.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$589.41
Rate for Payer: Priority Health Narrow Network	$589.41
Rate for Payer: Priority Health SBD	$589.41
Rate for Payer: UMR Bronson Commercial	$260.82

Know your out-of-pocket cost for care.

All Charges